R590-249-5. Examples

The following are examples of permissible policy limitations or exclusions and are not all inclusive: (1) a charge in connection with reconstructive or plastic surgery that may have a limited benefit, such as a chemical peel that does not alleviate a functional impairment; (2) a complication relating to services and supplies for, or in connection with: (a) gastric or intestinal bypass; (b) gastric stapling; (c) a similar surgical procedure to facilitate weight loss; (d) a procedure related to the reversal or revision of a procedure in Subsections (2)(a) through (2)(c); or (e) any direct complication or consequence of a procedure in Subsections (2)(a) through (2)(d); (3) a complication due to infection from a cosmetic procedure, except in a case of reconstructive surgery: (a) when the service is incidental to or follows a surgery resulting from trauma, infection, or other disease of the involved part; or (b) related to a congenital disease or anomaly of a covered dependent child that has resulted in functional defect; or (4) a complication that results from an injury or illness resulting from voluntary participation in an illegal activity described in Section R590-227-4.